Diagnostic methods

Parasitological diagnosis
Humans can serve as intermediate host for the fox tapeworm E. multilocularis, which excludes a parasitological diagnosis in stool samples.
With microscopy protoscolices can be detected in cyst fluids from surgical specimens.
Imaging technique (ultrasonography, computed tomography and magnetic resonance imaging) are diagnostically helpful

Molecular diagnosis
PCR detects parasite nucleic acids in needle biopsies or in stool samples of foxes or dogs (final hosts) with excellent sensitivity and specificity

Antigen detection
Several home-made tests detect copro-antigens in the faeces of definitive hosts by ELISA and specific monoclonal antibodies. One test kit is commercially available.

Antibody detection
Serology is an important diagnostic element for detecting alveolar echinococcosis. Various test formats (IFA, ELISAs, Western blots) have been developed to detect specific antibodies with a high sensitivity.
Using an affinity-purified or recombinant antigen (e.g. Em18), a differential diagnosis between the two species seems possible.

Diagnostic strategies

1. To diagnose an individual case
   Combining imaging techniques with serology is the best strategy today.
    
2. To assess endemicity in an exposed population
   Serology is the first choice!